Serious conditions such as stroke and coronary heart disease arising from atherosclerosis in the blood vessels of the brain or heart are widely feared. With worsening urban risk factors such as high cholesterol, high blood pressure, high blood sugar, smoking, and ageing, blood vessels throughout the body may gradually harden to varying degrees, lose elasticity, thicken, calcify, or even become blocked. Peripheral vascular disease refers to health problems caused by blood vessel disease outside the heart and brain, and atherosclerosis is one of the most common causes.

Clinically, the arteries in the lower limbs are among the most commonly affected. As people age, and particularly when these risk factors are present, the arterial walls in the legs may gradually thicken and the vessel lumen narrows; in severe cases, the artery may become completely blocked. When this reduces blood supply, it can cause intermittent claudication, meaning leg pain after walking a certain distance, most often in the calf muscles. Symptoms usually ease with rest, but as the disease worsens, the walking distance becomes shorter, and some patients may eventually feel pain even at rest. In advanced cases, non-healing ulcers and gangrene may develop, and if the problem is not managed appropriately, some patients may ultimately require amputation because of tissue loss in the limb.

Statistics cited in the original article suggest that intermittent claudication becomes more common with age. Surgeons can arrange treatment according to the patient’s condition. In earlier cases, medication may help relieve symptoms, and patients are often encouraged to perform appropriate exercise to maintain blood flow through collateral vessels. However, arteries that are already narrowed or blocked remain diseased.

For moderate to severe disease, interventional treatment may be required. In addition to conventional open surgery, minimally invasive endovascular treatment may also be used. Balloons or stents can be employed to widen narrowed or occluded arteries and restore blood supply to the leg. Compared with open surgery, endovascular procedures use much smaller wounds, may be performed under local anaesthesia, and generally allow faster recovery.

In general, a balloon catheter is advanced into the target vessel and inflated to widen the narrowed segment so that blood flow to the lower limb can improve. Because most affected arteries have already undergone disease-related changes, re-narrowing may still occur after treatment. The original article also mentions newer drug-coated balloons, which carry a medication layer intended to act on the vessel wall after dilation in order to help maintain vessel patency and blood flow for longer.

Author: Honorary Clinical Associate Professor, Department of Surgery, The University of Hong Kong; President, Vascular Health Foundation